Clinical Analysis Of Pneumocystis Pneumonia In Patients With AIDS And Non-AIDS Immune Function Inhibition

Objective:To compare the clinical features,laboratory tests,imaging findings,diagnosis,treatment,prognosis,and prognostic factors of AIDS-combined PCP and non-AIDS immunosuppressed patients with PCP,so as to improve clinicians' knowledge and diagnosis of PCP.Methods:The clinical data of patients with PCP admitted to Respiratory ICU,Comprehensive ICU,Emergency ICU,Department of Hematology,Nephrology and Rheumatology of the Second Affiliated Hospital of Nanchang University from January 2012 to October 2017 were collected.A total of 37 cases were included.Male 28,9 females.According to the presence or absence of human immunodeficiency virus infection,patients were divided into immunodeficiency virus-infected PCP(HIV-PCP)group and non-immune-defective virus-infected PCP(NH-PCP)group.The general conditions,clinical features,laboratory tests,imaging findings,diagnostic methods,treatment methods and prognosis of the two groups were retrospectively analyzed and compared.At the same time,the prognostic factors were analyzed.Statistical analysis Using SPSS 20.0 software,measurement data were first tested for normality.Measured data that corresponded to normal distribution were expressed as mean±standard deviation and t-test was used;non-normally distributed measurement data were median(quadruple The number of bits [M(QL,QU)] indicates that the Mann-Whitney U test was used.The count data was analyzed by Fisher's exact test;P<0.05 was considered statistically significant.Results:(1)Patients in the NH-PCP group had long-term history of glucocorticoids and/or immunosuppressive agents.There was no statistical difference in age between the two groups,but the NH-PCP group was more sick than the HIV-PCP group.See,the difference was statistically significant(P<0.05)(2)The patients in the NH-PCP group had more severe onset and hypoxemia.The difference was statistically significant(P<0.05).However,the two groups were similar in terms of fever,dyspnea,cough,and chest pain.The incidence of pneumothorax and mediastinal emphysema was higher in the NH-PCP group than in the HIV-PCP group,but the difference was not statistically significant(P>0.05).(3)HIV-PCP group of all patients CD4+T lymphocyte count were decreased,compared with the NH-PCP group,the difference was statistically significant(P < 0.05);and group HIV-PCP CD4+T lymphocyte count and CD4/CD8 ratio was significantly lower than that of NH-PCP group,the difference was statistically significant(P < 0.05);the two group(1-beta plasma 3)-D,dextran(BDG)total positive rate was 57.7%,the positive rate of group NH-PCP was 60%,the positive rate of HIV-PCP group was 54.55%,there was no statistically significant difference(P > 0.05).(4)The chest imaging findings were mainly composed of ground-glass,patchy,interstitial-like changes,ground-glass-combination patches,and nodule shadows.There was no significant difference between the two groups(P>0.05).(5)Twenty-five out of 37 patients with PCP underwent bronchoscopically bronchoalveolar lavage fluid(BALF)examination.The specimens were then stained with hexaammine silver,14 of them(56%)found Pneumocystis,and 1 was found in a sputum smear.Pneumocystis was found.Twelve patients did not undergo bronchoscopy because of refusal or other reasons.Therefore,15 cases were confirmed and 22 cases were diagnosed clinically.(6)In 37 cases of PCP patients,oral compound sulfamethoxazole was the first choice.The dose was SMZ 75-100mg/kg.d,TMP 15-20mg/kg.d,3-4 times orally,and the general course of treatment was 2-3 weeks.Among them,18 patients(mainly mild to moderate)were treated with SMZ/TMP alone,and 19 patients(mainly moderate to severe)received SMZ/TMP combined with caspofungin(first dose 70 mg,intravenous drip,followed by 50 mg/d maintenance).In treatment,25 patients(all moderate to severe)received glucocorticoid adjuvant therapy.There was no significant difference between the two groups(P>0.05).(7)Five patients in the NH-PCP group had a worsening condition and died of hospital discharge.Among them,1 was acute leukemia,1 was pemphigus,1 was lymphoma,1 was nephrotic syndrome,and 1 was idiopathic thrombocytopenia.Two patients in the HIV-PCP group died of illness and were discharged.The rest of the patients were discharged from the hospital or transferred to hospital for treatment.The mortality rate of NH-PCP group was higher than that of HIV-PCP,but this difference was not statistically significant(P>0.05).Analysis of causes of death in patients with PCP,death group showed older,more severe hypoxemia,more invasive mechanical ventilation and concurrent pneumothorax patients,the difference was statistically significant(P <0.05);compared to the beginning of SMZ-TMP treatment time,With 15 days as the limit,SMZ-TMP treatment was more effective than ?15 days,and the difference was statistically significant(P<0.05).Conclusion:(1)In recent years,the incidence of PCP in patients with non-AIDS immunosuppressed patients has been continuously increasing.Patients in the NH-PCP group have an acute onset of HIV-PCP,rapid progression,and severe hypoxemia.Most patients require mechanical ventilation.(2)Caspofungin combined with SMZ-TMP has a good therapeutic effect on PCP,and patients with severe clinical conditions may consider SMZ-TMP combined with caspofungin.(3)Age,arterial partial pressure of oxygen,invasive mechanical ventilation,combined pneumothorax,and initiation of SMZ-TMP treatment were independent risk factors for the prognosis of PCP.